The Children’s Hospital by Chris Adrian

Review by Scott Esposito
Tags: post-apocalypse

I.

E.M. Forster devotes a chapter of Aspects of the Novel to the quality of prophecy, telling us that very few authors write with it. The realm of prophecy, he writes “is not a veil, it is not an allegory. It is the ordinary world of fiction, but it reaches back.” We are, Forster continues, “not concerned with the prophet’s message . . . What matters is the accent of his voice, his song.” The prophet works within the realm of realism, but occasionally he “touches the objects so sedulously dusted by the hand of common sense, and renders them more vivid than they could ever be in domesticity.” At length, Foster remarks approvingly:

His theme is the universe, or something universal, but he is not necessarily going to “say” anything about the universe; he proposes to sing, and the strangeness of song arising in the halls of fiction is bound to give us a shock. How will song combine with the furniture of common sense? we shall ask ourselves, and shall have to answer “not too well”: the singer does not always have room for his gestures, the tables and chairs get broken . . .

By this definition, Chris Adrian’s magnificent novel The Children’s Hospital might just be prophecy. It is the story of the Apocalypse—the earth is buried under seven miles of rainwater, and the only thing to survive the flood is a hospital, its 700 child patients, and the doctors, nurses, staff, and parents that happened to be in the hospital at the time of the flood. There is an angel that inhabits the walls of the new hospital/ark, ensuring that all the humans’ needs are seen to as their new home heads off vaguely in the direction of the North Pole.

The principle inhabitant of the hospital is Jemma, a third year med student with the disposition and distinct distaste for conflict of the terminally stepped-on. Even cockroaches are her incessant accusers. After cursing herself for falling in love (because the four people she has ever loved all died horrible deaths) with Rob, a resident at the hospital, Jemma comes home to find the cockroach angry with her.

The roach skibbled down a cabinet and ran at her. When she fled it pursued her down that hall, running not just on the floor but on the walls an the ceiling in a big loose spiral. She got to her bedroom, slammed the door and stared anxiously at the space underneath it. It was big enough to admit to roaches, one piggy-backing on top of the other, but the roach didn’t come in. He never came into her bedroom—they seemed to have an agreement about that. Still, she imagined him scolding her from the other side of the door, just like a parent might. What were you thinking? he asked. Are you trying to kill him?

As with Adrian’s previous novel, Gob’s Grief, brothers are very important to The Children’s Hospital. The adult Jemma is very much a product of her older (by three years) brother; he mentored her as a child and his horrible suicide at age 17 set the stage for the guilt the wracks the rest of her life. She won’t love anyone partly because of her brother’s death, and she won’t marry anyone because her brother made her swear not to. Her incessant mourning for her brother is perhaps her most defining feature.

When the waters appear, the doctors develop a slogan: Just do the work. Forget that you’re witnesses to the Apocalypse, damnit, we have a hospital to run. There’s a certain nobility to this dedication, but as one might expect from such an unfeeling response, the doctors are mostly painted by Adrian as stuffy and self-important disciplinarians that order students and residents around with barely disguised contempt. The nobility and great intelligence that they do have is consistently undermined by intense pride. The parents show more range, running from annoyingly overprotective to bossy to compassionate to funny. Then there’s the nurses and Jemma’s fellow interns—some are as malign as the doctors, but with others Jemma forms loose friendships.

Lastly, there are the children, which, in their dizzying, disgusting array of afflictions repeatedly instill intense sympathy and seem to uniquely embody the sentence “the meek shall inherit the earth.” So bad are these diseases that the teenager with cancer seems to get off easy. There’s an autistic child who periodically goes through weeks of vomiting and has to be fed intravenously, slowly upping the amount to trick his body into accepting food again. There’s a little girl with a surgically constructed vagina and anus (she was born without either) who is perpetually hooked up to tubes and who carries around in a little red wagon bags of fluids meant to do the work of her missing digestive system. There are preemies—children born as early as 25 weeks into a pregnancy, riddled with birth defects, living off of tubes and machines.

For The Children’s Hospital’s first third, Adrian’s book takes on the feel of a consummate med student novel. Jemma, unable to mourn for the lost world like everyone around her, is sucked into the routine tortures of her daily rounds. Adrian, who experienced this world firsthand as a student, admirably conveys Jemma’s uncertainty and frustration at treating sick children that are often impudently resistant to her attempts to heal them. For instance, in this scene Jemma is searching through a family of nine children for one named Kidney, whose “hideous constipation” she has to get to the root of:

“It’s a doctor,” said the first one, directly above Jemma on the top bunk.

“Student,” said the third one, by the winder. “The coat is short.”

“Who’s Kidney?” Jemma asked.

“We all are Kidney,” said the one in the top bunk, “and none of us are Kidney.”

“A doughnut,” said the one by the winder. “Don’t talk to it.”

“Don’t talk to it.”

“Don’t talk to it.”

“I’m kind of in a hurry,” Jemma said, “and I’m here to help. I’m Jemma. I’m a student doctor.”

“You are a doughnut,” said the one by the window, a girl. . . .

“Okay,” Jemma said, turning on the light. “Everybody up.” She sat them up and counted all nine of them, and examined the two girls who appeared to be around five. Both of them were too ticklish for a good belly exam.

II.

This part of the novel is effectively and succinctly ended when Jemma, about three months pregnant with what we suspect is not just any child, discovers the ability to heal anyone with a miraculous green fire flowing from her fingertips. Against the admonishments of the (likely envious) doctors and the stern wills of many hospital citizens who are frightened of her, she goes on a rampage and heals every child in the hospital in one night. This scene is, hands-down, one of best reads in the entire book. Jemma’s many intimately described healings could have grown tedious in the wrong hands, but in Adrian’s each new healing comes as a new revelation. Just as he does with characters, he finds the small, rich details that make each unique.

Of special interest here is the ambiguity concerning many of the diseases Jemma eradicates. The autistic cells, for example, beg Jemma’s mercy, asking her why they are so wrong, why they must be eliminated from the world. A fair question, given the claims of Disability Studies that those with autism experience the world in a way that is different but just as valid as that of “normal” people. Is it right to eliminate them? Is a child “fixed” once he’s been cured of autism? Adrian’s inclusion of this question brings much depth to this scene, not in the least because, similarly, all the humans dead in the flood might wonder why God had to kill them.

The hospital, deprived of its raison d’etre, tries to reconfigure itself for its new civilian role. A government of sorts is established. Bars and roller rinks are constructed. Former med students become children’s teachers. Of course, this cannot last forever. Adrian—never revealing his hand—seems to be indicting his creations for treating it all just like a floating Club Med. This is still the Apocalypse, after all. Predictably enough, a splinter group does form and tries to look for “the reason” behind the flood. Nevertheless, the gears of the Apocalypse continue to implacably turn. The Recording Angel records for the next generation’s scripture, the Accusing Angel comes aboard and starts accusing, and the Destroying Angel eventually arrives to “revoke the promise of survival and redemption, and to teach them the awful truth about furious sheltering grace.”

Throughout, Adrian does a wonderful job of combining the miraculous with the mundane. Jemma is a fully drawn character, and her tragic past is especially well presented in a number of flashbacks to the childhoods of her and her brother. The hospital is imagined in rich detail—Adrian expends whole paragraphs describing precise features of his world—and many members of this large cast, although not nearly as deeply drawn as Jemma, are vividly portrayed and followed as they wind off along their own plotlines. This world seems so real that we might forget its incredible setting were it not for the magic Adrian casually litters it with—”replicators” that the Preserving Angel uses to make whatever the humans desire, a perpetual motion machine, the mystery surrounding Jemma’s powers and her baby. These parts are never embellished; Adrian never stoops to give us a message, or to make anyone or anything a symbol. Rather, as Forster says, he just sings his song, every now and then knocking through the thin drywall of reality.

There is only one major flaw with this novel, and that is in Jemma’s love interest, Rob, who remains a two-dimensional character throughout. Simple curiosity implores Adrian to tell us more about this man who is the father of what will likely be a very significant baby. Moreover, as we read we begin to wonder why Rob is so in love with Jemma that he continues in the face of her constant rebuffs (first, because she fears her love will kill him, and, secondly, because she swore to her brother that she would never marry). It isn’t that obvious why he would love Jemma, something of a putz with low self-esteem. What’s in it for Rob? Why is he so single-minded to be with Jemma? Alas, the source of this love that lies at the heart of this mammoth novel remains an unsatisfying mystery.

The only other problem I see is the pacing, so assured in the first and last thirds, but faltering in the middle. There’s too much of the government council debating this, the council debating that; too much of the citizens running off on their own errands once the children are healed. Although some of it is good and worth keeping, much of it feels like empty plotting that delays us from getting on with the business at hand. I would have preferred for Adrian to explore Jemma and Rob’s relationship here, or to have given us more of his excellent glimpses of Jemma’s childhood.

III.

No doubt, The Children’s Hospital is beautifully written and a great read, but what does it all mean?

Let’s start with the hospital’s physical body. On one level, it is a pregnancy, the hospital’s nine circular floors representing the nine months. The Preserving Angel, we are told, “lives within the walls,” assumes the hospital as her body. She repeatedly coos lovingly to the humans (just as Jemma speaks to her baby) and requires that they stay healthy, but beyond that doesn’t enter into their affairs. On the other hand, the nine circular floors might be the nine circles of hell. More than one character reflects miserably (especially when the going gets rough) that no one can leave. Moreover, these survivors are stuck with the nightmare of their deceased loved ones and the end of all civilization—it’s no surprise that many grow depressed. The Angel, ostensibly benevolent, often feels carefully malign—like a runaway nanny state government—and when she wants something she finds inexorable ways to compel it.

The beating heart of this womb/hell is “the toy,” a perpetual motion machine made to look like one of those Rube Goldberg-ish contraptions that endlessly cycles a ball through a series of obstacles. Of course, any perpetual motion machine necessarily violates the laws of physics, and this one seems to be a reminder that for the duration of the journey that the normal rules do not apply. God’s will is among them, and He can do anything—even alter the laws of the universe He created. It’s a reminder of how very little control the humans actually have, as well as perhaps a symbol of their journey as a species: after the twists and turns of History, here they are again, another flood, a world wiped clean waiting for them to inevitably soil.

Then there’s the fact of the setting: why a children’s hospital? There are the obvious angles—suffering without purpose, the innocence of children. Truly, who more worthy to inherit the earth than those whose lives have been pointlessly ruined from (in many cases) the moment they set foot onto it?

On another level, the hospital is a symptom of a humanity that can no longer summon the will to care. This is best exemplified by Dr. Walnut, a pompous surgeon who at one point operates on a tiny premature baby. Throughout the surgery, he treats the baby like so much meat, and eventually

“Eureka!” he said finally. He held the sick bowel up for all of them to see; it was purple, except where it was mottled black . . . “Five, seven, fifteen centimeters, I think, and the valve too. Ah, poor short-gut baby!”

After this, Dr. Walnut then invites Jemma to “make the first cut” (but not before he boorishly presides over five minutes of light-adjustment) and the transition from suffering human to Thanksgiving turkey is complete. This care without really caring, which Adrian repeatedly presents as the reality of this hospital (and one would presume, others), is mirrored by many of the survivors who believe that the reason for the flood was that humanity had simply grown too callous to the suffering of others.

And lastly, there is the family aspect of a children’s hospital. Jemma’s tragic, personal family history, the repetition of the “lost brother” theme, and Adrian’s own grief for his brother, make it clear that families cut to the heart of this novel. Adrian, in fact, implies that Jemma’s family may be at the root of everything. The children’s hospital, as the focal point that brings together all kinds of families into the bonds of a similar trauma, comes to represent the ways that families can go wrong and the pain that they can saddle generations with. Within this book is a very impassioned plea for the importance of the family.

The great strength of The Children’s Hospital, however—that which I think may qualify it for Forster’s label of prophecy—is that Adrian remains mum about any of this. He resists the urge to turn characters into symbols, to turn his myth into an allegory. All he does is tell a very affecting, very consistent story, and it is on this level that The Children’s Hospital primarily satisfies. Several of Adrian’s scenes and characters feel so right that they cannot help but extend beyond the confines of the tale and loom large as something more. But this is the result of good writing, not of an attempt to make this book “mean something.” Read meaning into it, then—there is much food for thought here—but most of all, just read it.

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